On June 09, 2021 a
Exhibit,Appendix
was filed
involving a dispute between
Security Mutual Life Insurance Company Of New York,
and
Arie Dov Fried,
Basi Schwartz,
Fried Devorah,
Shlomo Schwartz,
for Commercial - Insurance
in the District Court of Broome County.
Preview
FILED: BROOME COUNTY CLERK 03/25/2022 04:21 PM INDEX NO. EFCA2021001401
NYSCEF DOC. NO. 43 RECEIVED NYSCEF: 03/25/2022
"G"
EXHIBIT
FILED: BROOME COUNTY CLERK 03/25/2022 04:21 PM INDEX NO. EFCA2021001401
FILED: BROOME INDEX NO. EFCA2021001401
COUNTY CLERK 10/29/2021 09:22 AM|
NYSCEF DOC. NO. 43 RECEIVED NYSCEF: 03/25/2022
NYSCEF DOC, NO. 14 . RECEIVED.NYSCEF: 10/29/2021
STATE OF NEW YORK ; COUNTY OF ROCKLAND
. AF FIDAVIT
SCHWARTz AND
SHLOMO SCHWARTS and BASI(E) TECUM'
SUBPEONA DUCES
',
AFFIANTS
CLAINANT(S) and BEN EFICIARY(IES) ".
POLICY NUMBER :
001268414
vs.
SECURITY MUTUAL LIFE INSURANCE COMPANY IMSURED NAME :
OF NEW YÓRR RUCHEL STERN
K
GREETINGS:
Shlomo Schwartz and Basi(e) Schwartz (Maiden name Stern),
residing at 5 Walter New York 10952 affirm
Drive, Monsey, hereby
and submit the under peDalties of perjury.
following
1. I, Basi (AKA Basie) Schwartz am a daughter of Ruchel Stern
also known as Rozalia Stern (Maiden name Moskowitz),
And I, Shlomo husband of Basi Sokwartz (married over
Schwartz,
50 years), are natural and legal heirs of the deceased
Ruchel Stern that was residing at 166 South 9th Street Apt. # 3-G
Brooklyn, New Yourk 11211,
2. It was personally known to us from our parents that ƒe are
beneficiaries of Security Mutual Life Insurance Company of N.Y.
Policy Number 001268414. Accordingly, we have a legitimate
interest and legal right in making the within request to produce
information relating'to the above
a_nLY and all documents and
mentioned Policy.
3. Wherefore, we hereby request Security Mutual Life.
Insurance Company of New York to produce to us the documents and
information including, but not limited to, the following:
a.) Date of inception of said Policy;
b.) Type of Policy
c.) Face amount of ibsurance;
d.) Names of Benefiaries at time of issue o f Policy;
e.) Name and address of Agent of Record at issue of
Policy;
f.) Schdule of premiums to paid;
g.s) Amount of premium paid at inception of the Policy;
h.) A detailed history of a_ny and a_11 transactions made
to the such as interest, additional .
Policy, loans,
premiuits, dividends, withdrawls, partial surrender,
cash value;
4 of 16
FILED: BROOME COUNTY CLERK 03/25/2022 04:21 PM INDEX NO. EFCA2021001401
FILED: BROOME COUNTY CLERK INDEX NO. EFCA2021001401
10/29/2021 09:22 AM|
NYSCEF DOC. NO. 43 RECEIVED NYSCEF: 03/25/2022
NYSCEF DOC. NO. 14 RECEIVED NYSCEF: 10/29/2021
- 2 -
i.) A of the Policy and application attached thereto;
copy
3.) A of changes and/or amendmends made to the
copy any
Policy since it's inception until todate;
k.) Any claims made or submitted against the Policy, and
by whom, whether paid or not, or pending;
1.) Any other documents and/or information not specified
above.
4. Furthermore, we request that any claims submitted under this
Policy should be put on hold, until any questions regarding the
rightfull beneficiaries are fully resolved.
5. The requeste documents and informátion should be mailed to
Shlomo and Basi Schwartz, 5 Walter Drive, Monsey, New York 10952.
Failure to comply with this Subpeone Duces Tecum, will result in
further legal action.
Enclosed please find a copy·of Certificate of Naturalization,
Death Certicate, and Social Security Card for Rozalia Stern.
/Shlomo/chwa tz . Basi Schwartz
NOTARIZATION
State of New York )
) as.:
County of Rockland )
Before me Israel Oster, a Notary Public in and for the
State of New York, on this 18th day of March, 2021,
personally,appeared Mr. Shlomo.Schwartz, and Mrs,,Basi Schwartz
'both of whom are personally known to me and executed the
within instrument and signed their names under penalty of perjury.
In witness thereof, I have set my signature and notary seal
on this 18th day of March, 2.021.
ISRAELOSTER .
''
NotaryPublic,StateofNew%rk
No 01086033041 . Israel bster
QualiftedinRocklandCounty
Commission ×poresSep 12 2010
5 of 16
Document Filed Date
March 25, 2022
Case Filing Date
June 09, 2021
Category
Commercial - Insurance
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FILED: BROOME COUNTY CLERK 03/25/2022 04:21 PM INDEX NO. EFCA2021001401 NYSCEF DOC. NO. 43 RECEIVED NYSCEF: 03/25/2022 "G" EXHIBIT FILED: BROOME COUNTY CLERK 03/25/2022 04:21 PM INDEX NO. EFCA2021001401 FILED: BROOME INDEX NO. EFCA2021001401 COUNTY CLERK 10/29/2021 09:22 AM| NYSCEF DOC. NO. 43 RECEIVED NYSCEF: 03/25/2022 NYSCEF DOC, NO. 14 . RECEIVED.NYSCEF: 10/29/2021 STATE OF NEW YORK ; COUNTY OF ROCKLAND . AF FIDAVIT SCHWARTz AND SHLOMO SCHWARTS and BASI(E) TECUM' SUBPEONA DUCES ', AFFIANTS CLAINANT(S) and BEN EFICIARY(IES) ". POLICY NUMBER : 001268414 vs. SECURITY MUTUAL LIFE INSURANCE COMPANY IMSURED NAME : OF NEW YÓRR RUCHEL STERN K GREETINGS: Shlomo Schwartz and Basi(e) Schwartz (Maiden name Stern), residing at 5 Walter New York 10952 affirm Drive, Monsey, hereby and submit the under peDalties of perjury. following 1. I, Basi (AKA Basie) Schwartz am a daughter of Ruchel Stern also known as Rozalia Stern (Maiden name Moskowitz), And I, Shlomo husband of Basi Sokwartz (married over Schwartz, 50 years), are natural and legal heirs of the deceased Ruchel Stern that was residing at 166 South 9th Street Apt. # 3-G Brooklyn, New Yourk 11211, 2. It was personally known to us from our parents that ƒe are beneficiaries of Security Mutual Life Insurance Company of N.Y. Policy Number 001268414. Accordingly, we have a legitimate interest and legal right in making the within request to produce information relating'to the above a_nLY and all documents and mentioned Policy. 3. Wherefore, we hereby request Security Mutual Life. Insurance Company of New York to produce to us the documents and information including, but not limited to, the following: a.) Date of inception of said Policy; b.) Type of Policy c.) Face amount of ibsurance; d.) Names of Benefiaries at time of issue o f Policy; e.) Name and address of Agent of Record at issue of Policy; f.) Schdule of premiums to paid; g.s) Amount of premium paid at inception of the Policy; h.) A detailed history of a_ny and a_11 transactions made to the such as interest, additional . Policy, loans, premiuits, dividends, withdrawls, partial surrender, cash value; 4 of 16 FILED: BROOME COUNTY CLERK 03/25/2022 04:21 PM INDEX NO. EFCA2021001401 FILED: BROOME COUNTY CLERK INDEX NO. EFCA2021001401 10/29/2021 09:22 AM| NYSCEF DOC. NO. 43 RECEIVED NYSCEF: 03/25/2022 NYSCEF DOC. NO. 14 RECEIVED NYSCEF: 10/29/2021 - 2 - i.) A of the Policy and application attached thereto; copy 3.) A of changes and/or amendmends made to the copy any Policy since it's inception until todate; k.) Any claims made or submitted against the Policy, and by whom, whether paid or not, or pending; 1.) Any other documents and/or information not specified above. 4. Furthermore, we request that any claims submitted under this Policy should be put on hold, until any questions regarding the rightfull beneficiaries are fully resolved. 5. The requeste documents and informátion should be mailed to Shlomo and Basi Schwartz, 5 Walter Drive, Monsey, New York 10952. Failure to comply with this Subpeone Duces Tecum, will result in further legal action. Enclosed please find a copy·of Certificate of Naturalization, Death Certicate, and Social Security Card for Rozalia Stern. /Shlomo/chwa tz . Basi Schwartz NOTARIZATION State of New York ) ) as.: County of Rockland ) Before me Israel Oster, a Notary Public in and for the State of New York, on this 18th day of March, 2021, personally,appeared Mr. Shlomo.Schwartz, and Mrs,,Basi Schwartz 'both of whom are personally known to me and executed the within instrument and signed their names under penalty of perjury. In witness thereof, I have set my signature and notary seal on this 18th day of March, 2.021. ISRAELOSTER . '' NotaryPublic,StateofNew%rk No 01086033041 . Israel bster QualiftedinRocklandCounty Commission ×poresSep 12 2010 5 of 16